Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Stroke. 2011 Aug;42(8):2333-5. doi: 10.1161/STROKEAHA.111.614214. Epub 2011 Jun 9.
There is uncertainty whether warfarin-treated patients (despite international normalized ratio < 1.7) have increased risks of symptomatic intracerebral hemorrhage after intravenous thrombolysis.
Vascular risk factors, stroke subtype, and outcome measures were compared between warfarin- and nonwarfarin-treated patients undergoing acute thrombolysis within 3 hours of symptom onset.
From 212 patients (mean age, 74 ± 14 years; 50% men) studied, 14 (6.5%) had prior warfarin use. After adjusting for age, baseline National Institutes of Health Stroke Scale, and stroke subtype, warfarin-treated patients had significantly increased risks of developing symptomatic intracerebral hemorrhage (adjusted OR, 14.7; 95% CI, 1.3 to 54.3). A trend for poorer stroke recovery and increased mortality was observed in warfarin-treated patients on univariate, but not on multivariable, analyses.
Warfarin-treated patients with stroke have increased risks of symptomatic intracerebral hemorrhage after thrombolytic treatment. These data raise safety concerns of thrombolytic treatment in warfarin-treated patients with subtherapeutic international normalized ratio.
尽管国际标准化比值（INR）<1.7，但华法林治疗的患者在接受静脉溶栓治疗后是否有更高的症状性颅内出血风险仍存在不确定性。
比较了在症状发作后 3 小时内接受急性溶栓治疗的华法林治疗和非华法林治疗患者的血管危险因素、卒中和亚型以及预后评估指标。
在 212 例（平均年龄 74±14 岁，50%为男性）患者中，有 14 例（6.5%）患者在入组前曾使用华法林。在校正年龄、基线国立卫生研究院卒中量表（NIHSS）评分和卒中和亚型后，华法林治疗的患者发生症状性颅内出血的风险显著增加（校正比值比，14.7；95%置信区间，1.3 至 54.3）。尽管单变量分析显示华法林治疗的患者有较差的卒中恢复和更高的死亡率趋势，但多变量分析并未显示这一趋势。
接受溶栓治疗的华法林治疗的卒中患者有更高的症状性颅内出血风险。这些数据提示了在 INR 低于治疗范围的华法林治疗患者中进行溶栓治疗的安全性问题。
